Case study:The Gastrointestinal System

1.The alimentary canal includes: the oral cavity, pharynx, esophagus, stomach, small
intestine, large intestine, and anus. Aspirin causes a small amount of bleeding in the
stomach, and may cause the stools to become hemoccult positive.

2.The hematocrit value that supports the gastroenterologist's diagnosis is 37. In

anemia the Hct is low. Normal hematocrit is 45, and a hematocrit of 55 may be seen
in polycythenia.

3.The mean corpuscular volume that supports the gastroenterologist's diagnosis is

75. In iron deficiency anemia the MCV is low. Because the red cells are smaller, it is
called a microcytic anemia. A mean corpuscular volume of 89 is normal, and a MCV
of 103 is found in B-12 deficiency anemia.

4.The mean corpuscular hemoglobin concentration that supports the

gastroenterologist's diagnosis is 30. In iron deficiency anemia the mean corpuscular
hemoglobin concentration is low, patients look pale and are called hypochromic. A
MCHC of 34 is normal.

the ferritin is 5. The ferritin level that supports the gastroenterologist's diagnosis is
9. In iron deficiency anemia low. Ferritin measures iron stores and actually drops
before the Hct. A ferritin level of 110 is normal. A ferritin level of 600 is high and is
seen in disorders of excess accumulation of iron, such as hemochromatosis.

6. In the sigmoid colon, small outpouchings of the colonic mucosa called diverticuli
are seen. Most patients with diverticulosis (which means the condition of having
diverticuli in the large intestine) are asymptomatic, but some patients may develop
acute hemorrhage from the diverticuli. Mild to moderate bleeding often stops
spontaneously with bed rest and blood transfusion. Severe bleeds may be fatal
without treatment. Another symptom of diverticulosis is diverticulitis, which is
inflammation of the diverticuli. There may be localized inflammation in the region of
the diverticuli, abscess formation, and even peritonitis.

7. There is a large polyp in the descending colon; the surface is nodular which may
suggest a malignancy. However, tissue samples need to be examined by a
pathologist in order to tell whether the polyp is benign or malignant.
8. There is a small polyp in the transverse colon; it is flesh-colored and has a lower
probability of being malignant compared to the polyp in the descending colon. It is
also less likely that it caused the iron deficiency.

9.Carcinoma in situ is not metastatic because cancers above the basement

membrane do not have access to blood vessels or the lymphatic system.

10.Iron is absorbed by the duodenum. The formation of soluble iron complexes is

important for maintaining iron in an absorbable form. Gastric acid facilitates the
chelation of inorganic iron with substances such as ascorbic acid (vitamin C). This
keeps the iron soluble, and facilitates absorption. In contrast, other agents found in
the diet (such as oxalates) combine with iron to form insoluble complexes that
cannot be absorbed.